Provider Demographics
NPI:1659415768
Name:CAMACHO, MIGDONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGDONIO
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CALLE RAMON SAAVEDRA
Mailing Address - Street 2:PO BOX 1501
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1766
Mailing Address - Country:US
Mailing Address - Phone:787-895-5881
Mailing Address - Fax:787-895-5881
Practice Address - Street 1:152 RAMON SAAVEDRA STREET
Practice Address - Street 2:BOX 1501
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-5881
Practice Address - Fax:787-895-5881
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10375146D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF27542Medicare UPIN
PR0082639Medicare ID - Type Unspecified